A career in oncology: Only courageous need apply
She opened her session with this statement: “When I meet you in clinic, I will shake your hand. Five years later, only four of ten patients whose hands I shook will still be alive.” My oncologist from MD Anderson stood in front of the audience, presenting on the treatment of Inflammatory Breast Cancer (IBC). Appearing far younger than her 40-something age, the tips of her hair fashionably dyed blonde and radiating a vivacious energy, she more resembled a professional tennis player than a seasoned cancer physician.
Most who apply to medical school seek a career in which they are able to use their wisdom, skills and training to heal. However, some oncology specialties plunge the practitioner into a career entangled with patients who will rarely be cured and many who will ultimately die of their disease. Glioblastoma, an aggressive form of brain cancer, and pancreatic cancer are examples. Despite massive advances in research and treatment, IBC still accounts for a disproportionate number of deaths from breast cancer. Typically, we think of cures and restoration of health as the benchmarks of success, but illnesses such as these often result in different expectations. The oncologists and their teams form genuine, caring connections with patients, even as death looms as a common reality in their practices. With a therapist’s compassion and a researcher’s curiosity, oncology doctors guide patients through difficult conversations, threading the needle with both hope and realistic assessments.
These highly-specialized physicians spend their careers awash in human suffering and vulnerability. They counsel, cajole, assess, evaluate, prescribe, research and interpret. Like firefighters who run toward the inferno, oncologists charge after disease, studying its features, learning its tricks, and identifying its weaknesses. A formidable opponent, they seek to outwit cancer, predicting where it might go next and erecting blockades to prevent it from venturing further into the body. While machines peer deep inside bones and organs, the hands and eyes of the oncologist are indispensable tools of their trade. Palpating and prodding, fingers fluttering, they seek the telltale signs of disease. Through touch, they listen for the secrets the body holds close and with powers of observation honed by experience and training, they often detect illness or medication reactions. A subtle shift in our countenance, tenderness, or slight swelling may signal trouble to their accomplished eyes. Experience makes ailments a familiar territory.
Each of us patients represents a puzzle to be solved; identifying the carriers of a disease process that require an expert’s skills to heal. And each of us brings our own fears, resiliencies, idiosyncrasies and unique ways of coping into the treatment arena. Thrown together by fate and rogue cells that staged a riot, we almost always meet our physicians at a time of great stress. Newly diagnosed or dealing with a progression, we are ushered into an exam room and come face to face with a human who will assume great importance in our lives.
I came to trust my first oncologist because she never sugar-coated her assessment. That she served up the bad news straight meant that I could believe her when she delivered good news. Toward the end of my chemotherapy, she thought the cancer might be gaining ground and I could tell she was torn about how to proceed. There were risks with going to surgery too early but an aggressive cancer not responding to chemo was an equally serious matter. As I left the appointment that day, I heard footsteps pounding behind me. I turned to find my oncologist running down the hallway, her ballet flats thwacking against the carpet. “If this gets any worse, you need to call me right away,” she said, out of breath from the effort to catch up. That day, I realized we were fully in this together; a committed partnership.
The best of the oncologists preserve an open heart, leaning into our lives with compassion and courage. We develop a delicate intimacy with our treatment providers who shepherd us through agonizing moments and harrowing treatments. Should we have a future, it is they who will deliver us to the Promised Land. We are accustomed to thinking of intimacy as a reciprocal, deeply emotional and sometimes physical partnership. In oncology, the rules are jumbled. Reciprocity is tempered by professional boundaries; we are patient and doctor, after all, not family members or spouses. The relationship is heavily weighted toward the physical but is driven by fear and anxiety and has nothing to do with desire, unless you count a yearning to stay alive.
One day on the MD Anderson walkway, I heard a distinctive British accent and instantly knew to whom it belonged. Dr. Schaverien, who has led or participated in three of my four cancer surgeries, animatedly conversed with a colleague. I walked past as though we were complete strangers, not wanting to disrupt his discussion even with a casual greeting. It struck me that this man has laid eyes on more of my body’s real estate than I’ll ever see (or want to see!) and, although he has devoted hours to standing at my side, I don’t remember any of it because I was under anesthesia. He split me open from hip to hip, scooped lymph nodes out of my groin, created a new breast from my abdominal skin and tummy fat, and closed me up with a cluster of Texas-sized drains swinging from my torso. After my second mastectomy, he pulled the bandages back and together we viewed the footlong scar where my breast had lived until recently.. “Are you a bit nervous to see it?” he asked and then we both laughed. “Oh right, you’ve done this before.”
Our closeness is not conventional, but we share a meaningful connection. At our pre-surgery appointments, I can count on Dr. Schaverien as a calming presence, often reminding me that if a complication occurs, “it is my problem to figure it out.” When a CT scan revealed an unusual pattern of lymph nodes, he took it in stride. “Nothing for you to worry about,” he said with reassuring confidence. One fall afternoon, as we prepared for a mastectomy the following day, Dr. Schaverien and I traded in light-hearted banter. I leaned up against a wall, as though I was being arrested, while he used a black Sharpie to draw on my back where he planned to remove skin to close the surgical wound. I asked if he could take some fat along with the skin. He remarked that, “I suspect not much gets you down, Mrs. Cory.” That man gets me. (And he always calls me Mrs. Cory even though there is no Mr.).
After my first mastectomy, I awaited the post-surgery pathology report with a mixture of dread and anticipation. It would reveal how well the chemo worked and have significant bearing on the plan for future treatment. My oncologist walked in, waving a piece of paper, her eyes lit up. “What do you think this says?” she asked, although her beaming face told me everything I needed to know. The chemo had done its job and I had the miracle; the pathologic complete result, or PCR, which meant that the chemo had cleared all the cancer. No one had mentioned that I had only an 8% chance of getting the PCR, and I was glad I didn’t know ahead of time. My doctor declared that I had basically won the cancer lottery and dispatched me to a celebratory dinner. Our physicians and their teams celebrate the good news and treatment milestones because they desire our healing as much as we do. In some way, they must mourn the losses, too.
Immersed in the mysteries of human illness, doctors continually face the reality of human vulnerability and sometimes find themselves as patients. My current oncologist is a two-time cancer survivor, someone who underwent extensive treatment and ventured close to death. He joined a panel of oncologists who spoke about their personal cancer treatments, revealing how his own illness enhanced his commitment to his profession. In his presence, I experience a preternatural calm, perhaps because he has faced the worst himself. When we first met to discuss my new diagnosis, he slipped into the room as quietly as a monk would enter a chapel. He introduced himself in almost a whisper, with the same tone one might use while praying before an altar. I blurted out that I had never missed a day of my anti-estrogen medication, designed to prevent recurrence, as if to bolster myself against blame for the misfortune of a second cancer. The first words he spoke were, “It isn’t your fault,” and sweet relief flooded through me like an arc of sunlight on a bitterly cold day. He understood from the inside out, as only one could who had shared in the same journey.
I will forever remember my cancer physicians; they are part of my heart’s inner circle. Doctors Mina, Bahadur, Lim, Ueno, Woodward (who offered tourist tips for those unfamiliar with Houston), Teshome, Hwang and the charming Brit who favors fuchsia socks, Dr. Schaverien.
Five years ago, Dr. Lim first shook my hand in the clinic. Six of the ten patients whose hands she clasped during that summer are gone now, including some of the fierce and lovely women whom I met during our shared treatment. I’m still here.